摘要
目的:探讨单开门颈椎管扩大成形Centerpiece钛板内固定术治疗颈椎管狭窄症的早期临床疗效。方法:2009年8月～2010年6月采用后路C3～C7单开门椎管扩大成形Centerpiece钛板内固定术治疗颈椎管狭窄症患者30例,其中男性23例,女性7例,年龄42～81岁,平均65.2岁。MRI显示3个节段狭窄9例,4个节段狭窄15例,5个节段狭窄6例。以JOA评分(17分法)及其改善率评价术后神经功能改善情况;术后复查颈椎X线、CT及MRI,在术前及术后3d、6个月的颈椎侧位X线片上测量C5节段椎管矢状径,计算椎管扩大率[(术后椎管矢状径-术前椎管矢状径)/(术前椎管矢状径)×100%],评价椎管扩大和维持情况及门轴侧骨融合情况。结果:手术时间为145±20min,术中出血量为215±75ml,术中未出现相关并发症。1例术后第2天出现C5神经根症状,经2周保守治疗疼痛明显缓解,术后2个月时症状完全消失。随访9～20个月,平均14.6个月,术前JOA评分为8.7±0.8分,术后6个月为15.2±1.1分,改善率为(75±8)%。影像学复查示术后3d、6个月时颈椎管扩大满意,脊髓受压完全解除,C5节段椎管矢状径术前为9.2±0.8mm,术后3d、6个月均为15.9±1.2mm,椎管扩大率为(71.8±11.0)%。术后6个月时门轴侧均达骨性愈合,无1例出现关门及神经损害症状加重的情况。结论:单开门颈椎管扩大成形Centerpiece钛板内固定术是治疗颈椎管狭窄症的一种简便、安全的方法,早期疗效较满意。
Objective：To evaluate the early clinical efficacy of unilateral open-door cervical expansive laminoplasty plus centerpiece titanium plate fixation for cervical spinal stenosis.Method：From August 2009 to June 2010,30 cases suffering from cervical spinal stenosis underwent unilateral open-door expansive lanfino- plasty plus centerpiece fixation,of these,there were 23 males and 7 females,with a mean age of 65.2 years （range, 42-81 years ） .Preoperative MRI showed stenosis at three levels in 9 cases,four levels in 15 and five levels in 6.The neurofunction was evaluated by Japan Orthopaedic Association （JOA） score;X-ray,CT and MRI were used to evaluate postoperative spinal canal enlargement and bone fusion at the hinge side.The sagittal diameter of C5 spinal canal on the lateral X-ray was measured before operation and 3 days,6 months after operation respectively,and the expansion rate of spinal canal was termed [as（postoperative sagittal diameter-preoperative sagittal diameter）/（preoperative sagittal diameter） x100% ].Result ： The average operation time was 145±20min;the average intraoperative blood loss was 215±75ml;no complications was noted during operation.C5 palsy was noted in 1 case l day after operation,which was relieved significantly after 2 weeks of correspondent intervention and resolved completely 2 months after operation.All patients were followed up for 9-20 months （mean 14.6 months）. The average JOA score for preoperation was 8.7±0.8 and 15.2±1.1 at 6 months after operation,with the improvement rate of （75±8）%.Radiographic findings showed spinal canal enlarged perfectly at 3 days and 6 months after operation.The mean sagittal diameter of C5 spinal canal was 9.2＋0.8mm before operation and 15.9＋1.2mm at 3 days and 6 months after operation,with the expansion rate of （71.8±11.0）%.CT sean showed bony fusion at hinge side at 6 months after operation without reeurrence of cervical stenosis and neurofunction deterioration.Conclusion：Unilateral open-door expansive laminoplasty plus centerpiece titanium plate fixation is simple and reliable,and the early elinieal efficacy is satisfaetory.
出处
《中国脊柱脊髓杂志》
CAS
CSCD
北大核心
2011年第8期654-658,共5页
Chinese Journal of Spine and Spinal Cord
